Digestive Disorders CE/CME ACCREDITED Watch Time: 26 mins

touchEXPERT OPINIONS Improving patient outcomes in moderate-to-severe ulcerative colitis

Watch leading experts discuss important considerations in the optimal management of patients with moderate-to-severe ulcerative colitis.

Now Playing:
Up Next:
 
Prof. Ailsa Hart
St Mark's Hospital and Academic Institute, London, UK
What is the significance of the disease burden of ulcerative colitis when assessing patients?

Prof. Hart discusses the significant burden that ulcerative colitis places on patients both clinically and psychosocially, which should be proactively managed as part of a patient-centred care approach to improve overall quality of life. 

1/3 Next Interview
Take CE/CME Test

In this interview Prof. Ailsa Hart answers the following questions:

  • How does a diagnosis of ulcerative colitis impact patients’ lives?
  • How can we assess and treat the full impact of ulcerative colitis on patients in clinical practice?
  • How do current treatment options impact quality of life for patients with moderate-to-severe ulcerative colitis, and how should challenging symptoms be managed?

Ailsa Hart is Consultant Gastroenterologist at St Mark’s Hospital and Dean of St Mark’s Hospital Academic Institute, London, UK. read more

In 2016, she achieved academic promotion at Imperial College London, UK, and is now Professor of Practice. She is also Honorary Skou Professor at the University of Aarhus in Denmark. She studied medicine at Oxford University and was awarded a First-Class Honours degree. She achieved her PhD with Imperial College London, funded by a Wellcome Trust Fellowship.

Prof. Hart has mentored and trained many gastroenterologists, who are now clinical investigators engaged in inflammatory bowel disease (IBD) research nationally and internationally. Together with many of them, she has published two books and over 250 papers, reviews and book chapters. She is currently on the governing board of the European Crohn’s and Colitis Organisation (ECCO) as scientific officer and was past treasurer and member of the Clinical Committee of ECCO. She is on the IBD Clinical Research Group Committee for the British Society of Gastroenterology (BSG) and is past chair of the Gut Microbiota for Health Group of the BSG. She is the UK patient and public involvement lead for gastroenterology and is on the research committee for the Crohn’s and Colitis UK charity. She is a member of the International Organization for the Study of Inflammatory Bowel Disease.

Prof. Ailsa Hart discloses: Advisory board or panel fees from AbbVie, Bristol Myers Squibb, Dr Falk Pharma, Janssen, Merck Sharp & Dohme, Pfizer, Roche and Takeda.

 
Dr Gil Y Melmed
Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
The importance of timely diagnosis and early treatment in ulcerative colitis: Why does it matter?

Dr Melmed discusses why a timely diagnosis and early treatment in ulcerative colitis is so important including the potentially progressive nature of the disease, prognostic risk factors, current treatments for moderate-to-severe vs mild ulcerative colitis, and therapeutic drug monitoring as a useful approach for optimal management.   

2/3 Next Interview
Take CE/CME Test

In this interview Dr Gil Melmed answers the following questions:

  • When considering early diagnosis and treatment in ulcerative colitis, what can we learn from Crohn’s disease?
  • What do we need to evaluate to ensure ulcerative colitis is diagnosed and treated at an early stage?
  • How does the treatment of moderate-to-severe disease differ compared with mild disease?
  • How can we further improve outcomes for patients with moderate-to-severe ulcerative colitis?

Gil Y Melmed, MD, MS, is Co-director of the Inflammatory Bowel Disease Center at Cedars-Sinai Medical Center in Los Angeles, California, USA. He earned his medical degree from Albert Einstein College of Medicine in the Bronx, New York, and master of science in clinical research from UCLA School of Medicine, Los Angeles. He completed his gastroenterology fellowship at the University of California, Los Angeles. read more

Dr Melmed has authored or co-authored more than 150 articles in peer-reviewed journals and several book chapters. Dr Melmed has served as associate editor of the American Journal of Gastroenterology, and clinical research editor for Inflammatory Bowel Disease. His interests include clinical outcomes and quality of care in inflammatory bowel disease (IBD), as well as translational prognostic and therapeutic strategies to improve inflammation and clinical outcomes. He has led or participated in the development of quality indicators for IBD with the American Gastroenterology Association, the Crohn’s and Colitis Foundation, the National Quality Forum, and the Canadian Crohn’s and Colitis organizations.

Dr Gil Melmed discloses: Consultancy fees from AbbVie, Arena Pharmaceuticals, Boehringer Ingelheim, Bristol Myers Squibb, Ferring, Janssen, Medtronic, Oshi, Pfizer, Samsung Bioepis, Shield Therapeutics, Takeda and Techlab; Grants/research support from Pfizer; Other financial or material support (royalties, patent, etc.) from Aytu Biosciences; and Stocks/shares (self-managed) from Nephroceuticals.

 
Prof. Brian G Feagan
University of Western Ontario, London, ON, Canada
How might emerging therapy options in ulcerative colitis impact current clinical practice?

Prof. Feagan discusses the primary considerations for the development of new therapies for the treatment of moderate-to-severe ulcerative colitis, and the emerging drug classes/therapeutic targets showing greatest potential. He shares his expert insight on how the changing treatment landscape may impact clinical practice.

3/3 Take CE/CME Test
Take CE/CME Test

In this interview Prof. Brian Feagan answers the following questions:

  • When considering the current treatment landscape in ulcerative colitis, what are the key issues that emerging therapies should address?
  • What are the targets currently under investigation for novel therapies in ulcerative colitis?
  • What are the latest data for S1P receptor modulators in ulcerative colitis?
  • What are the latest data for JAK inhibitors in ulcerative colitis?
  • What are the latest data for other small molecules in ulcerative colitis?
  • How do you think the landscape will change in the treatment of moderate-to-severe ulcerative colitis in the next 5–10 years?

Brian Feagan completed a medical degree at the University of Western Ontario (UWO) in London, Ontario, Canada. His postdoctoral training included a residency in internal medicine and a clinical fellowship in gastroenterology in the Department of Medicine at UWO, and postgraduate training in the Department of Epidemiology and Biostatistics at McMaster University, Hamilton, Ontario. read more

A fellow of the Royal College of Physicians and Surgeons of Canada, Prof. Feagan holds membership in the Canadian and American Association of Gastroenterology, the American College of Gastroenterology, the College of Physicians and Surgeons of Ontario, Crohn’s and Colitis Canada, and the European Crohn’s and Colitis Organization. He has authored over 480 articles and book chapters and has given over 600 invited presentations at national and international scientific meetings. In 1997, Prof. Feagan became Director of Robarts Clinical Trials at the Robarts Research Institute, UWO and in 2020, he became Senior Scientific Director of Alimentiv Inc. (formerly Robarts Clinical Trials). His research efforts focus on the design and implementation of randomized controlled trials of therapy for inflammatory bowel disease. He has been the principal investigator on numerous large-scale randomized clinical trials.

Prof. Brian Feagan discloses: Advisory board or panel fees from AbbVie, Amgen, Boehringer Ingelheim, Celgene/Bristol Myers Squibb, EcoR1 Capital, Genentech/Roche, GlaxoSmithKline, InDex Pharmaceuticals, Janssen, Morphic Therapeutic, Novartis, Origo BioPharma, Pfizer, Progenity, Prometheus, Takeda, Teva and Tillotts Pharma; Consultancy fees from AbbVie, AdMIRx, AgomAb Therapeutics, Akebia Therapeutics, Alimentive Inc., Alivio Therapeutics, Allakos, Amgen, Applied Molecular Transport Inc., Arena Pharma, Avir, Azora Therapeutics, Boehringer Ingelheim, Celgene/BMS, Connect BioPharma, Cytoki, Everest Clinical Research Corp., Eli Lilly, Ferring, Galapagos, Galen Pharma/Atlantica, Genentech/Roche, Gilead, GlaxoSmithKline, Gossamer Pharma, Hoffmann-La Roche, InDex Pharmaceuticals, Intact Therapeutics, Janssen, Kaleido Biosciences, Millennium, Morphic Therapeutics, Mylan, Origo BioPharma, Pandion Therapeutics, Pfizer, Progenity, Prometheus Therapeutics and Diagnostics, PTM Therapeutics, Rebiotix, RedHill Biopharma, Sandoz, Sanofi, Seres Therapeutics, Surrozen Inc., Takeda, Teva, Thelium, Theravance, Tigenix, Tillotts Pharma, UCB Pharma, VHsquared Ltd, Viatris, Ysios and Zealand Pharma; Speaker bureau fees from AbbVie, Janssen and Takeda; and Stocks/shares (self-managed) from Gossamer Pharma.

Take CE/CME Test
Overview & Learning Objectives
Overview

In this activity, three experts consider aspects that are crucial to improving outcomes in patients with moderate-to-severe ulcerative colitis: the significance of disease burden when assessing patients; the importance of timely diagnosis and early treatment; and the potential of emerging treatment options.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of immunologists and gastroenterologists involved in the management of ulcerative colitis.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity.  The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Prof. Ailsa Hart discloses: Advisory board or panel fees from AbbVie, Bristol Myers Squibb, Dr Falk Pharma, Janssen, Merck Sharp & Dohme, Pfizer, Roche and Takeda.

Dr Gil Melmed discloses: Consultancy fees from AbbVie, Arena Pharmaceuticals, Boehringer Ingelheim, Bristol Myers Squibb, Ferring, Janssen, Medtronic, Oshi, Pfizer, Samsung Bioepis, Shield Therapeutics, Takeda and Techlab; Grants/research support from Pfizer; Other financial or material support (royalties, patent, etc.) from Aytu Biosciences; and Stocks/shares (self-managed) from Nephroceuticals.

Prof. Brian Feagan discloses: Advisory board or panel fees from AbbVie, Amgen, Boehringer Ingelheim, Celgene/Bristol Myers Squibb, EcoR1 Capital, Genentech/Roche, GlaxoSmithKline, InDex Pharmaceuticals, Janssen, Morphic Therapeutic, Novartis, Origo BioPharma, Pfizer, Progenity, Prometheus, Takeda, Teva and Tillotts Pharma; Consultancy fees from AbbVie, AdMIRx, AgomAb Therapeutics, Akebia Therapeutics, Alimentive Inc., Alivio Therapeutics, Allakos, Amgen, Applied Molecular Transport Inc., Arena Pharma, Avir, Azora Therapeutics, Boehringer Ingelheim, Celgene/BMS, Connect BioPharma, Cytoki, Everest Clinical Research Corp., Eli Lilly, Ferring, Galapagos, Galen Pharma/Atlantica, Genentech/Roche, Gilead, GlaxoSmithKline, Gossamer Pharma, Hoffmann-La Roche, InDex Pharmaceuticals, Intact Therapeutics, Janssen, Kaleido Biosciences, Millennium, Morphic Therapeutics, Mylan, Origo BioPharma, Pandion Therapeutics, Pfizer, Progenity, Prometheus Therapeutics and Diagnostics, PTM Therapeutics, Rebiotix, RedHill Biopharma, Sandoz, Sanofi, Seres Therapeutics, Surrozen Inc., Takeda, Teva, Thelium, Theravance, Tigenix, Tillotts Pharma, UCB Pharma, VHsquared Ltd, Viatris, Ysios and Zealand Pharma; Speaker bureau fees from AbbVie, Janssen and Takeda; and Stocks/shares (self-managed) from Gossamer Pharma.

Content reviewer

Patrick Brady, MD, has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Christina Mackins-Crabtree has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu 

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu)

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credit for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 13 April 2022. Date credits expire: 13 April 2023.

If you have any questions regarding credit please contact cpdsupport@usf.edu

Learning Objectives

After watching this activity, participants should be better able to:

  • Describe the disease burden associated with ulcerative colitis and how it relates to patient management
  • Recognize the importance of early diagnosis and describe treatment options in patients with moderate-to-severe ulcerative colitis
  • Evaluate novel agents in development for the treatment of moderate-to-severe ulcerative colitis and consider how they may impact current clinical practice
Downloads

View and download resources from this activity to support your learning and share with colleagues

Register to touchIMMUNOLOGY for FREE
  • Peer-reviewed journals and expert opinions
  • Interactive CME and e-learning modules
  • Video conference highlights
Register For Free Now

This content is intended for healthcare professionals only. Please confirm that you are a healthcare professional.

Accept Decline
CE/CME Test (0.75 Points) Close
CE/CME Test

To obtain the CME credit(s), please complete this post-test. Please complete and click to see your results and continue.

Question 1/5
Which ulcerative colitis symptom do patients report as having the greatest impact on their quality of life?
Correct

There are only a few studies that have reported data on the impact of ulcerative colitis on daily life,1 with patients and physicians differing in their perception of the impact of symptoms.1 Indeed, 65% of patients felt that ulcerative colitis controlled their life rather than them controlling their disease.1 In a recent global survey, when asked, patients reported that rectal urgency (72%), fatigue (59%) and abdominal pain (56%) were the ulcerative colitis symptoms that they rated as having a high impact on their quality of life.2

Reference

  1. Dubinsky M. et al. Inflamm Bowel Dis. 2021:27;1747–55.
  2. Rubin D, et al. Inflamm Bowel Dis. 2021:27;1942–53.
Question 2/5
A 28-year-old woman with moderate ulcerative colitis presents to you for a routine clinic visit. What would be the ideal approach to evaluate the full impact of her condition on her quality of life?
Correct

Questions in the clinical interview such as “How are you emotionally handling everything?” or “What other areas of your life have been impacted by your IBD?” can be used to help develop rapport, communicate empathy, and can inform clinicians about any psychosocial concerns that patients may have. If a patient discloses any such concerns, clinicians should validate and address these, either within their existing capability, or else seek referrals for additional clinical expertise. 

IBD, inflammatory bowel disease.

Reference

Keefer L, et al. Gastroenterology. 2022;162:1439–51.

Question 3/5
When considering treatment in ulcerative colitis, what can we learn from Crohn’s disease?
Correct

Growing evidence indicates that ulcerative colitis may be considered a progressive disease like Crohn’s disease. Although early intervention is an established approach in Crohn’s disease, data on the impact of early intervention in ulcerative colitis are limited. However, inadequate control of the inflammatory burden with current treatments may provide a rationale for early intervention in some patients with ulcerative colitis to prevent disease progression.

Reference

Solitano V, et al. J Clin Med. 2020;9:2646.

Question 4/5
Colonoscopy results from your patient with ulcerative colitis, who is refractory to corticosteroids, reveals deep ulcers and extensive disease. What do you consider to be the most appropriate management strategy?

5-ASA, 5-aminosalicylate; MMX, multimatrix.
Correct

Management of moderate-to-severe ulcerative colitis encompases numerous drug classes, including TNF-α antagonists (infliximab, adalimumab, golimumab), anti-integrin agents (vedolizumab), JAK inhibitors (tofacitinib) and immunomodulators (thiopurines, methotrexate).1

In general, most drugs that are initiated for induction of remission are continued as maintenance therapy if they are effective.1 During disease monitoring, therapeutic drug monitoring can be useful, e.g. high serum induction/trough concentrations of infliximab are associated with endoscopic healing and clinical remission.2

JAK, Janus kinase; TNF, tumour necrosis factor.

References

  1. Feuerstein JD, et al. Gastroenterology. 2020;158:1450–61.
  2. Ungaro R, et al. Lancet. 2017;389:1756–70.
Question 5/5
What is the underlying mechanism of action of S1PR modulators as a novel drug class for ulcerative colitis?

S1PR, sphingosine 1-phosphate receptor; TNF, tumour necrosis factor.
Correct

S1PR modulators act as functional antagonists at lymphocytic S1P1 receptors, inhibit S1P1 receptor-dependent lymphocyte egress from the secondary lymphoid organs to the periphery and decrease numbers of circulating lymphocytes including autoreactive T cells, resulting in immunomodulatory effects.1 Ozanimod is the only currently licensed S1PR modulator for the treatment of moderate-to-severe ulcerative colitis.2,3

S1P, sphingosine 1-phosphate; S1PR, S1P receptor.

References

  1. Argollo, M. et al. Expert Opin Biol Ther. 2020;20:413–20.
  2. Ozanimod PI and SmPC available via the FDA and EMA, respectively at: www.accessdata.fda.gov/scripts/cder/daf/ and www.ema.europa.eu/en/medicines (accessed 10 March 2022).
Post Test Feedback Close
Step 1: Post CE/CME Test Feedback

Please note this feedback form is compulsory to complete your CE/CME evaluation

* = Mandatory Field

Please complete this short online feedback form.
Please indicate how well each statement met your expectations.

Accreditation Close
Accreditation

Please provide your details so that we can send you your certificate, which will be emailed to the address provided. All fields are required.

* = Mandatory Field
Your Accreditation Close
Copied to clipboard!
accredited arrow-down-editablearrow-downarrow_leftarrow-right-bluearrow-right-dark-bluearrow-right-greenarrow-right-greyarrow-right-orangearrow-right-whitearrow-right-bluearrow-up-orangeavatarcalendarchevron-down consultant-pathologist-nurseconsultant-pathologistcrosscrossdownloademailexclaimationfeedbackfiltergraph-arrowinterviewslinkmdt_iconmenumore_dots nurse-consultantpadlock patient-advocate-pathologistpatient-consultantpatientperson pharmacist-nurseplay_buttonplay-colour-tmcplay-colourAsset 1podcastprinter scenerysearch share single-doctor social_facebooksocial_googleplussocial_instagramsocial_linkedin_altsocial_linkedin_altsocial_pinterestlogo-twitter-glyph-32social_youtubeshape-star (1)tick-bluetick-orangetick-red tick-whiteticktimetranscriptup-arrowwebinar Sponsored Department Location NEW TMM Corporate Services Icons-07NEW TMM Corporate Services Icons-08NEW TMM Corporate Services Icons-09NEW TMM Corporate Services Icons-10NEW TMM Corporate Services Icons-11NEW TMM Corporate Services Icons-12Salary £ TMM-Corp-Site-Icons-01TMM-Corp-Site-Icons-02TMM-Corp-Site-Icons-03TMM-Corp-Site-Icons-04TMM-Corp-Site-Icons-05TMM-Corp-Site-Icons-06TMM-Corp-Site-Icons-07TMM-Corp-Site-Icons-08TMM-Corp-Site-Icons-09TMM-Corp-Site-Icons-10TMM-Corp-Site-Icons-11TMM-Corp-Site-Icons-12TMM-Corp-Site-Icons-13TMM-Corp-Site-Icons-14TMM-Corp-Site-Icons-15TMM-Corp-Site-Icons-16TMM-Corp-Site-Icons-17TMM-Corp-Site-Icons-18TMM-Corp-Site-Icons-19TMM-Corp-Site-Icons-20TMM-Corp-Site-Icons-21TMM-Corp-Site-Icons-22TMM-Corp-Site-Icons-23TMM-Corp-Site-Icons-24TMM-Corp-Site-Icons-25TMM-Corp-Site-Icons-26TMM-Corp-Site-Icons-27TMM-Corp-Site-Icons-28TMM-Corp-Site-Icons-29TMM-Corp-Site-Icons-30TMM-Corp-Site-Icons-31TMM-Corp-Site-Icons-32TMM-Corp-Site-Icons-33TMM-Corp-Site-Icons-34TMM-Corp-Site-Icons-35TMM-Corp-Site-Icons-36TMM-Corp-Site-Icons-37TMM-Corp-Site-Icons-38TMM-Corp-Site-Icons-39TMM-Corp-Site-Icons-40TMM-Corp-Site-Icons-41TMM-Corp-Site-Icons-42TMM-Corp-Site-Icons-43TMM-Corp-Site-Icons-44TMM-Corp-Site-Icons-45TMM-Corp-Site-Icons-46TMM-Corp-Site-Icons-47TMM-Corp-Site-Icons-48TMM-Corp-Site-Icons-49TMM-Corp-Site-Icons-50TMM-Corp-Site-Icons-51TMM-Corp-Site-Icons-52TMM-Corp-Site-Icons-53TMM-Corp-Site-Icons-54TMM-Corp-Site-Icons-55TMM-Corp-Site-Icons-56TMM-Corp-Site-Icons-57TMM-Corp-Site-Icons-58TMM-Corp-Site-Icons-59TMM-Corp-Site-Icons-60TMM-Corp-Site-Icons-61TMM-Corp-Site-Icons-62TMM-Corp-Site-Icons-63TMM-Corp-Site-Icons-64TMM-Corp-Site-Icons-65TMM-Corp-Site-Icons-66TMM-Corp-Site-Icons-67TMM-Corp-Site-Icons-68TMM-Corp-Site-Icons-69TMM-Corp-Site-Icons-70TMM-Corp-Site-Icons-71TMM-Corp-Site-Icons-72